A case of anti-neutrophil cytoplasmic antibody-associated vasculitis masquerading as Sjögren syndrome.

Anti-neutrophil cytoplasmic antibody (ANCA) -positive vasculitis is a small-vessel vasculitis that affects multiple body systems. Salivary gland involvement in ANCA-associated vasculitis is rare. When present, it mimics infection or malignancy, which might lead to misdiagnosis. In this report, we describe a 72-year-old man who presented with parotid and submandibular gland pain and swelling in addition to dry mouth and eyes. He had bilateral non-tender parotid gland lumps and no lymphadenopathies. Laboratory tests were positive for ANCA, hematuria, and proteinuria but negative for Anti-Ro and -La. He was treated with corticosteroids and cyclophosphamide for acute kidney injury. Unfortunately, the patient died a few months later. This case report sheds light on a rare manifestation of salivary gland involvement in ANCA-associated vasculitis that mimics Sjögren syndrome and the challenges associated with its diagnosis and treatment.

Acetabular fractures in the elderly: modern challenges and the role of conservative management.

INTRODUCTION : The incidence of acetabular fractures in the elderly population is ever increasing. While management of acetabular fractures in young patients following high-energy trauma is well described, treatment of the elderly patient subgroup is complex and requires a unique, individualized approach. A variety of treatment strategies including operative and non-operative approaches exists to manage this vulnerable patient group. Conservative management of acetabular fractures in the elderly continues to play an important role in treatment of both stable fracture patterns and those medically unfit for surgery. AIM : This review assessing the current literature was undertaken with the purpose of summarising the challenges of management in this at-risk cohort as well as quantifying the role and outcomes following conservative management in the elderly.  CONCLUSION: Our recommendation is that conservative management of acetabular fractures in the elderly can be considered as a treatment option on a case-by-case basis accounting for patient, injury, and surgical factors. If it is to be pursued, we advise a multidisciplinary approach focused on early mobility, minimisation of risk and regular follow-up to optimise patient outcomes.

Clinical Practice Guidelines For The Management Of Colorectal Cancer, A Consensus Statement By The Society Of Surgeons® And Surgical Oncology Society Of Pakistan®.

A joint effort by the Society of Surgeons Pakistan and Society of Surgical Oncology Pakistan, these guidelines provide a framework for the practicing surgeons involved in care and management of patients with colorectal cancer. The guidelines take into account the issues related to our local circumstances and provide a minimum standard of care that must be given to these patients. The Guideline Committee had members from all disciplines, including surgery, surgical oncology, medical oncology and radiation oncology. The guidelines have attempted to simplify things to understand and follow for the practicing surgeons. With these guidelines we wish to eliminate disparities in treatment among institutions and prevent any under treatment of patients.

Novel therapeutic drug strategies to tackle immune-oncological challenges faced by cancer patients during COVID-19.

INTRODUCTION: For the clinical treatment of cancer patients, coronavirus (SARS-CoV-2) can cause serious immune-related problems. Cancer patients, who experience immunosuppression due to the pathogenesis and severity of disease, may become more aggressive due to multiple factors such as age, comorbidities, and immunosuppression. In this pandemic era, COVID-19 causes lymphopenia, cancer cell awakening, inflammatory diseases, and a cytokine storm that worsens disease-related morbidity and prognosis. AREAS COVERED: We discuss all the risk factors of COVID-19 associated with cancer patients and propose new strategies to use antiviral and anticancer drugs for therapeutic purposes. We bring new drugs, cancers and COVID-19 treatment strategies together to address the immune system challenges faced by oncologists. EXPERT OPINION: The chronic inflammatory microenvironment caused by COVID-19 awakens dormant cancer cells through inflammation and autoimmune activation. Drug-related strategies to ensure that clinical treatment can reduce the susceptibility of cancer patients to COVID-19, and possible counter-measures to minimize the harm caused by the COVID-19 have been outlined. The response to the pandemic and recovery has been elaborated, which can provide information for long-term cancer treatment and speed up the optimization process.

Impact of the COVID-19 Pandemic on Pelvic and Acetabular Trauma: Experiences From a National Tertiary Referral Centre.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on daily life. Restrictions imposed to help minimise virus transmission have limited both population movement and employment, as well as altering the potential mechanisms of high-energy trauma. The objective of this study was to assess the impact of the COVID-19 pandemic on pelvic and acetabular trauma. Materials and methods A retrospective observational study of the incidence, causality, patient profile, fracture morphology, and treatment strategy of pelvic and acetabular trauma managed in a national tertiary referral specialist pelvic and acetabular centre between the 1st of March and 1st of August 2020 was undertaken and compared to corresponding time periods in the two preceding years. Results A total of 78 patients were referred for management following pelvic and acetabular trauma during the study period with a mean age of 52 years (SD +/- 24.2). Overall, 45% and 42% of patients were referred following isolated pelvic or acetabular fractures respectively. The most frequent mechanism of injury was a fall from height (>1m) (42%), with 53% of patients suffering from concomitant injuries and 32% requiring surgical management. While there was a statistically significant difference in mechanism of injury (P=0.026), there was no significant difference in overall incidence, fracture types, incidence of concomitant injuries, or overall proportion requiring surgical intervention during the study period when compared to previous years. Conclusion While some variation in the mechanisms of injury have been observed, the overall incidence, patient, fracture, and injury profiles associated with pelvic and acetabular trauma appear to have remained consistent during the COVID-19 pandemic. Additionally, the number and proportion of those requiring surgical treatment of these fractures have remained stable. Understanding the continued burden of these potentially severe injuries may help guide injury prevention, treatment, and resource allocation as the pandemic continues.

Role of nitrogen and magnesium for growth, yield and nutritional quality of radish.

Nitrogen (N) affects all levels of plant function from metabolism to resource allocation, growth, and development and Magnesium (Mg) is a macronutrient that is necessary to both plant growth and health. Radish (Raphanus sativus L.) occupies an important position in the production and consumption of vegetables globally, but there are still many problems and challenges in its nutrient management. A pot trial was conducted to investigate the effects of nitrogen and magnesium fertilizers on radish during the year 2018-2019. Nitrogen and magnesium was applied at three rates (0, 0.200, and 0.300 g N kg-1 soil) and (0, 0.050, and 0.100 g Mg kg-1 soil) respectively. The experiment was laid out in a completely randomized design (CRD) and each treatment was replicated three times. Growth, yield and quality indicators of radish (plant height, root length, shoot length, plant weight, total soluble sugar, ascorbic acid, total soluble protein, crude fiber, etc.) were studied. The results indicated that different rates of nitrogen and magnesium fertilizer not only influence the growth dynamics and yields but also enhances radish quality. The results revealed that the growth, yield and nutrient contents of radish were increased at a range of 0.00 g N. kg-1 soil to 0.300 g N. kg-1 soil and 0.00 g Mg. kg-1 soil to 0.050 g Mg. kg-1 soil and then decreased gradually at a level of 0.100 g Mg. kg-1 soil. In contrast, the crude fiber contents in radish decreased significantly with increasing nitrogen and magnesium level but increased significantly at Mg2 level (0.050 g Mg. kg-1 soil). The current study produced helpful results for increasing radish quality, decreasing production costs, and diminishing underground water contamination.

Retrospective study of ovarian malignancy managed in surgical unit at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore.

OBJECTIVE: To determine the oncological outcome and pattern of ovarian tumours in patients who underwent surgical management. METHODS: The retrospective, descriptive hospital-based study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data of all patients who underwent surgical intervention for ovarian cancer between January 2010 and December 2015. Data was retrieved from the hospital database and analysed using SPSS 20. RESULTS: Of the 236 patients, 203(86%) had undergone open surgery, while 33(14%) had had laparoscopic surgery. Neo-adjuvant chemotherapy was given in 60(25.42%) cases and adjuvant chemotherapy in 102(43.22%). Epithelial ovarian cancer in 201(85.16%) cases was the most common tumour type. Mortality was recorded in 36(15.5%) cases, while 41(19.9%) were lost to follow-up. CONCLUSIONS: Ovarian tumours were found to be difficult to treat and were associated with frequent recurrence.

An area efficient and high throughput implementation of layered min-sum iterative construction a posteriori probability LDPC decoder.

Area efficient and high speed forward error correcting codes decoder are the demand of many high speed next generation communication standards. This paper explores a low complexity decoding algorithm of low density parity check codes, called the min-sum iterative construction a posteriori probability (MS-IC-APP), for this purpose. We performed the error performance analysis of MS-IC-APP for a (648,1296) regular QC-LDPC code and proposed an area and throughput optimized hardware implementation of MS-IC-APP. We proposed to use the layered scheduling of MS-IC-APP and performed other optimizations at architecture level to reduce the area and to increase the throughput of the decoder. Synthesis results show 6.95 times less area and 4 times high throughput as compared to the standard min-sum decoder. The area and throughput are also comparable to the improved variants of hard-decision bit-flipping (BF) decoders, whereas, the simulation results show a coding gain of 2.5 over the best implementation of BF decoder in terms of error performance.

A retrospective study of endometrial stromal sarcoma: an institutional review.

This is a retrospective study conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, from January 1995 to April 2016, to determine the clinical presentations, pathological features, cancer free survival and rate of recurrence in patients with Endometrial Stromal Sarcoma (ESS). Data was collected from May to August 2017. A total of 31 patients with a mean age of 40.0±11.72 years were treated. Among them, 12 (38.7%) had stage I, 2 (6.4%) had stage II, 6 (19.3%) had stage III and 11 (35.5%) had stage IV ESS. All patients underwent surgical management as an initial treatment modality for ESS. Out of these 31 patients, 17 were under active surveillance, 4 had expired and 10 patients were lost to follow up. Eleven (65%) patients were disease free, recurrence was noted in 4 (23.5%) patients and 2 (12%) patients had persistent disease. Recurrence of disease was managed with surgical excision and multimodality treatment. Median duration of follow-up was 38.29 months. Endometrial stromal sarcoma (ESS) is a rare uterine tumour. Our patients were young and had lower rate of recurrence. Surgical management was the mainstay of treatment in patients with resectable disease while other options used included hormonal therapy, radio therapy or chemotherapy.

Hepatic Artery Variations in a Sample of Pakistani Population.

OBJECTIVE: To identify the frequency of different arterial variants of common hepatic artery (CHA) overview identified at abdominal CT angiography (CTA) performed in a large series of patients undergoing CT scans for various reasons. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Surgical Oncology and Radiology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan, from October 2016 to September 2018. METHODOLOGY: Findings in randomly selected 1000 patients who underwent CTA were retrospectively evaluated. The pattern of aortic origin of branches of the celiac trunk and superior mesenteric arteries was analysed. The CHA anatomy was then investigated. Hepatic artery anomalies were classified by the Hiatt's method. RESULTS: There were 629 males and 371 females with a median age of 54 years. Type 1 variation (normal anatomy) was seen in 644 patients. Type 2 variation (left hepatic artery, LHA, aberrations), was seen in 135 patients. LHA was seen arising from left gastric artery or common hepatic artery (CHA) in most of the cases. One patient had a replaced LHA from superior mesenteric artery (SMA). Sixteen patients had an accessory LHA and 119 had a replaced LHA. Type 3 variation (unusual anatomy of right hepatic artery, RHA) was seen in 121 patients, 7 patients had an accessory and 114 had a replaced RHA . The replaced or accessory right hepatic artery originated anywhere from SMA, celiac trunk, aorta, CHA or gastroduodenal artery (GDA). Type 4 variation (unsual origin of both RHA and LHA) was seen in 73 patients. Type 5 variation (CHA arising from SMA) was seen in 23 patients. Type 6 variation (CHA arising directly from aorta) was seen in four patients. CONCLUSION: Arterial variations are common in our population of patients. A detailed understanding and knowledge of these variations is necessary for surgeons and radiologists to avoid any inadvertent injuries during various procedures.

Effectiveness of Laparoscopic Skills Workshop on Enhancing Knowledge and Skills of Surgical Residents and Its Comparison with DOPS (Direct Observation of Procedural Skills) Scores: Prospective Cohort Study.

INTRODUCTION: Simulation-based surgical skills workshops are commonly used in the surgical training programs to enhance the knowledge and psychomotor skills of the residents, but there is scarcity of objective data on their effectiveness. The aim of our study was to explore if a 1-day laparoscopic skills workshop enhanced the knowledge and skills of surgical residents in minimal access surgery and if it had any correlation with the Direct Observation of Procedural Skills (DOPS) scores. METHODS: This was a quasi-experimental, single-arm, repeat measure, prospective cohort study design. Thirty-three residents from general surgery and obstetrics/gynecology programs of Aga Khan University participated in the study. A daylong laparoscopic skills workshop consisting of lectures, videos, and hands-on practice was offered. The pre-workshop knowledge and skills scores of residents were assessed and compared with immediate post-workshop scores and scores of repeat assessment at 2 months. The scores of DOPS on laparoscopic procedures before and after the workshop were also compared. RESULTS: The results of our study indicated that mean post-workshop (p < 0.001) and interval scores (p < 0.001) for both cognitive and psychomotor skills were significantly higher compared with mean pre-workshop scores. Similarly, post-workshop DOPS scores were significantly higher (p < 0.011) compared with pre-workshop DOPS scores. CONCLUSIONS: One-day laparoscopic skills workshop resulted in significant improvement in knowledge and psychomotor skills of the surgical residents. The skills gained from the workshop also resulted in improvement of DOPS scores reflecting the transfer of skills to real-life performance. TRIAL REGISTRATION: ClinicalTrials.gov registration number: NCT03982927.

Total hip arthroplasty for the treatment of osteoarthritis secondary to acetabular fractures treated by open reduction and internal fixation.

BACKGROUND: Acetabular fractures are associated with damage to the femoral head, acetabular cartilage and labrum and possible disruption of the femoral head blood supply. Treatment aims to provide the best opportunity for restoration of joint function and to prevent long-term complications. Surgical intervention, in the form of open reduction and internal fixation (ORIF), is often required. Where post-traumatic osteoarthritis develops after ORIF, total hip arthroplasty (THA) is often required. Our aim here has been to identify and highlight our experience with the key technical points associated with successful outcomes for THA in this setting. METHODS: A single-centre retrospective review of patients with acetabular fractures treated with ORIF and subsequent THA over a 4-year period was undertaken. Demographics, mechanism of injury, complications, interval time between surgeries, intra-operative outcomes and post-operative outcomes were recorded. Particular emphasis is made to describe standard pre-operative and intra-operative protocols. RESULTS: Twenty-five patients were identified, with a mean age of 51.1 years at time of first ORIF. 60% presented following RTA. 80% of fractures involved the posterior wall or column. Meantime to eventual THA was 2.3 years. Mean THA duration was 1.52 h, with mean intra-operative blood loss and length of stay of 585 ml and 5 days, respectively. 24% required intra-operative removal of metal, with only one patient suffering a complication post-THA. CONCLUSION: Acceptable post-operative outcomes were demonstrated throughout the case series. In describing the pre-operative work up, intra-operative findings and intra-operative and post-operative complications encountered, common important technical points associated with a successful surgical strategy are described. Furthermore, potential pitfalls that may be encountered can be anticipated.

Is pelvis x-ray essential in stable trauma patients? Step towards lowering the treatment cost.

OBJECTIVE: To determine the diagnostic accuracy of clinical examination in detecting pelvic fractures in patients with blunt trauma.. METHODS: The cross-sectional prospective study was conducted at Aga Khan University Hospital, Karachi, from January to June 2015, and comprised alert, awake blunt-trauma patients. Pelvis examination findings were compared to routine pelvic X-rays. SPSS 19 was used for data analysis.. RESULTS: Of the 133 patients, 122 (92%) were males. Overall mean age was 37 ±14.2 years. There were 14 (10%) patients who were true positives with pelvic fracture diagnosis on both clinical examination and pelvic X-ray, while 14 (10%) were false negative on examination. Clinical examination missed 2 patients with evidence of fracture on X-ray and were considered false positive. Besides, 103 (77.4%) patients were true negative as both clinical exam and X-ray showed no evidence of fracture. CONCLUSION: Omitting pelvic X-ray in the recommended protocol can avoid unnecessary financial burden and reduce undesirable radiation exposure..

Effect of Low-Intensity Pulsed Ultrasound on Distraction Osteogenesis Treatment Time: A Meta-analysis of Randomized Clinical Trials.

OBJECTIVES: The objectives of this systematic review with a meta-analysis were to critically analyze the available scientific literature regarding the effects of low-intensity pulsed ultrasound (US) on stimulating bone regeneration and bone maturation during distraction osteogenesis in humans and to determine whether the stimulatory effect of low-intensity pulsed US can effectively reduce the associated treatment time. METHODS: Studies were considered for inclusion if they were randomized clinical trials that examined the effect of low-intensity pulsed US on distraction osteogenesis compared to conventional distraction osteogenesis. The primary outcome was reduced treatment time. Study selection, risk of bias assessment, and data extraction were performed in duplicate. A random-effects meta-analysis model was used when more than 3 trials were eligible for a quantitative analysis and considering the expected differences in interventions and measurement tools. RESULTS: Five randomized clinical trials, with a moderate to high risk of bias, met the eligibility criteria. Four trials examining tibial distraction osteogenesis in 118 patients were combined in a meta-analysis. A statistically significant difference for reduced treatment time between distraction osteogenesis with low-intensity pulsed US and standard distraction osteogenesis was evident (mean difference, -15.236 d/cm; random-effects 95% confidence interval, -19.902 to -10.569 d/cm; P < .0001). As for the mandible, only 1 clinical trial was available, which showed no significant effect of low-intensity pulsed US therapy on distraction osteogenesis. CONCLUSIONS: Current available evidence suggests that low-intensity pulsed US therapy may provide a reduction in the overall treatment time for tibial distraction osteogenesis. However, this conclusion should be considered with caution, given the moderate to high risk of bias in the included randomized clinical trials.

Effect of low-intensity pulsed ultrasound on orthodontically induced root resorption caused by torque: A prospective, double-blind, controlled clinical trial.

OBJECTIVES: To evaluate the effects of low-intensity pulsed ultrasound (LIPUS) on orthodontically induced tooth root resorption caused by torque in human subjects. MATERIALS AND METHODS: Ten healthy patients (12-35 years of age) who required extraction of all first premolars as a part of their routine orthodontic treatment were recruited. A 15° twist was applied in the arch wire using 0.019 × 0.025-inch TMA in a 0.022-inch bracket system (Synergy R) that produced a buccal root torque of approximately 5 N/mm at the bracket level. Using a split mouth design, randomization, and blinding, one side of the arch received LIPUS for 20 minutes per day for 4 weeks at an incident intensity of 30 mW/cm(2) of the transducers' surface area. The other side served as a self-control, which received a sham transducer. After 4 weeks, all first premolars were extracted and micro-computed tomographic analysis was performed on these extracted teeth. A linear mixed-model statistical analysis was used. RESULTS: LIPUS-treated teeth showed significantly less total volume of resorption lacunae compared to control teeth by a mean difference of (0.54 ± 0.09 mm(3)) (P < .001) and percentage of root resorption by a mean difference of (0.33 ± 0.05 mm(3)) (P < .001). In addition, significantly fewer resorption lacunae were found on all root surfaces in the LIPUS group compared to the control except in the instance of the distal surface. LIMITATIONS: This study was performed on limited number of cases during a 4-week period. CONCLUSIONS: LIPUS minimizes root resorption when applied during torque tooth movement over a 4-week period.

Rapid maxillary expansion effects in Class II malocclusion: a systematic review.

OBJECTIVE: To evaluate the effectiveness of rapid maxillary expansion (RME) on the sagittal dental or skeletal parameters of growing children with Class II malocclusion. MATERIALS AND METHODS: A systematic review intended to identify relevant literature was conducted. The search was performed on Medline, Embase, Cochrane Library, and Scopus databases. Reference lists of the included articles were also screened for relevant documents. The qualitative assessment was performed according to the Methodological Index for Non-Randomized Studies (MINORS) tool, and the resultant data were grouped and analyzed concerning dental and skeletal sagittal effects of RME. RESULTS: Of 25 screened studies, seven articles met eligibility criteria and were included. Study samples were observed during mixed dentition stage and characterized as having either Class II dental malocclusion or skeletal discrepancy. None of the included studies was a randomized clinical trial. Included controlled studies presented several inadequacies related to control group or lacked appropriate comparative statistical analysis. Besides being frequently based on deficient methodology, dental and skeletal sagittal effects of RME were either controversial or lacked clinical relevance. CONCLUSION: The effect of RME on the sagittal dimension of Class II malocclusions has not been proved yet. Future randomized controlled clinical trials are still needed to definitely address this question.

Angiographic embolization for major trauma in a low-middle income healthcare setting--A retrospective review.

INTRODUCTION: Interventional radiology (IR) provides a range of adjunctive techniques to assist with hemorrhage control after trauma that can be employed pre- or post-operatively. The role of IR in lower-middle income countries (LMICs) remains unexplored. This study describes the use of adjunctive angioembolization (AE) in severely injured patients following its recent implementation at an urban trauma center in a LMIC. METHODS: Adult patients (≥ 16 years) requiring AE from 2011 to 2013 at a single trauma-care facility were included. Data was collected on demographic parameters, transfer status, injury severity score (ISS), emergency resuscitation characteristics, AE and operative characteristics, complications, and in-hospital mortality. Descriptive analyses were performed. RESULTS: Thirty six patients underwent AE for trauma-related hemorrhagic complications and were included in the study. Average age was 31.5 (± 11.3) years with a male preponderance (91.7%). Penetrating trauma (61.1%) was the most common type of injury. The primary mechanism of injury was gunshot (58.3%). The median ISS was 24 (IQR: 20-29). Pre-operative AE was performed in 23 (63.9%) patients and these patients had a lower median ISS (22) than those who underwent post-operative AE (p = 0.015). Hepatic (55.6%) and pelvic (33.3%) trauma more commonly required radiological intervention. Bleeding from the right hepatic (n = 14), and the right internal iliac (n = 6) arteries and/or their branches, were more often embolized. Microcoils were the preferred AE agents (61.1%). Median length of hospital stay was 7.5 (IQR: 3-14) days. Eight (22.2%) patients did not survive. CONCLUSION: With the availability of multi-detector computed tomography and a dedicated interventional radiology suite, implementation of AE for the care of trauma patients in LMIC settings is possible.

Acute compartment syndrome in orthopedics: causes, diagnosis, and management.

Almost all orthopaedic surgeons come across acute compartment syndrome (ACS) in their clinical practice. Diagnosis of ACS mostly relies on clinical findings. If the diagnosis is missed and left untreated, it can lead to serious consequences which can endanger limb and life of the patient and also risk the clinician to face lawsuits. This review article highlights the characteristic features of ACS which will help an orthopaedic surgeon to understand the pathophysiology, natural history, high risk patients, diagnosis, and surgical management of the condition.

Impact of a predefined hospital mass casualty response plan in a limited resource setting with no pre-hospital care system.

INTRODUCTION: Pre-hospital triage is an intricate part of any mass casualty response system. However, in settings where no such system exists, it is not known if hospital-based disaster response efforts are beneficial. This study describes in-hospital disaster response management and patient outcomes following a mass casualty event (MCE) involving 200 victims in a lower-middle income country in South Asia. METHODS: We performed a single-center, retrospective review of bombing victims presenting to a trauma center in the spring of 2013, after a high energy car bomb leveled a residential building. Descriptive analysis was utilized to present demographic variables and physical injuries. RESULTS: A disaster plan was devised based on the canons of North-American trauma care; some adaptations to the local environment were incorporated. Relevant medical and surgical specialties were mobilized to the ED awaiting a massive influx of patients. ED waiting room served as the triage area. Operating rooms, ICU and blood bank were alerted. Seventy patients presented to the ED. Most victims (88%) were brought directly without prehospital triage or resuscitation. Four were pronounced dead on arrival. The mean age of victims was 27 (±14) years with a male preponderance (78%). Penetrating shrapnel injury was the most common mechanism of injury (71%). Most had a systolic blood pressure (SBP) >90 with a mean of 120.3 (±14.8). Mean pulse was 90.2 (±21.6) and most patients had full GCS. Extremities were the most common body region involved (64%) with orthopedics service being consulted most frequently. Surgery was performed on 36 patients, including 4 damage control surgeries. All patients survived. CONCLUSION: This overwhelming single mass-casualty incident was met with a swift multidisciplinary response. In countries with no prehospital triage system, implementing a pre-existing disaster plan with pre-defined interdisciplinary responsibilities can streamline in-hospital management of casualties.

Hip reconstruction osteotomy by Ilizarov method as a salvage option for abnormal hip joints.

Hip joint instability can be secondary to congenital hip pathologies like developmental dysplasia (DDH) or acquired such as sequel of infective or neoplastic process. An unstable hip is usually associated with loss of bone from the proximal femur, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. In this case series of 37 patients coming to our institution between May 2005 and December 2011, we report our results in treatment of unstable hip joint by hip reconstruction osteotomy using the Ilizarov method and apparatus. This includes an acute valgus and extension osteotomy of the proximal femur combined with gradual varus and distraction (if required) for realignment and lengthening at a second, more distal, femoral osteotomy. 18 males and 19 females participated in the study. There were 17 patients with DDH, 12 with sequelae of septic arthritis, 2 with tuberculous arthritis, 4 with posttraumatic arthritis, and 2 with focal proximal femoral deficiency. Outcomes were evaluated by using Harris Hip Scoring system. At the mean follow-up of 37 months, Harris Hip Score had significantly improved in all patients. To conclude, illizarov hip reconstruction can successfully improve Trendelenburg's gait. It supports the pelvis and simultaneously restores knee alignment and corrects lower-extremity length discrepancy (LLD).